A pH Monitoring Test, also known as an Esophageal pH Monitoring or Esophageal pH Test, is a procedure that has been designed to measure the reflux of acid from the stomach into the esophagus, to help determine if symptoms experienced in the upper gastrointestinal tract is caused by acid reflux.   The pH monitoring test is used to diagnose gastro-esophageal reflux, more commonly referred to as GERD.  GERD is diagnosed based on the amount of stomach acid that enters the esophagus, and how well it is cleared.  The test may also be utilized to determine the effectiveness of preventative acid reflux medications.

The following is information regarding the pH monitoring test procedure, how you can prepare for it, as well as answers to other common questions you may have.

First, let’s take a look at how the pH monitoring test is performed.  The pH monitoring test involves passing a slim plastic catheter through one nostril.  As the patient swallows, the catheter moves down the back of the patient’s throat, and into the esophagus, where it rests just above the lower esophageal sphincter (LES ).  The end of the catheter that rests above the LES  contains a sensor that is designed to detect acid.  While in place, the sensor will detect every instance of acid reflux that occurs, and will send this information to the recorder attached to the other end of the catheter that protrudes from the nose.  This recorder registers each reflux of acid.

Once the procedure of inserting the catheter is complete, the patient is then sent home with the catheter and recorder in place.  The patient goes about his/her regular activities (I.E. eating, sleeping, working, etc.).  During a 24 hour period, the patient is asked to record their meals, their periods of sleep, and any symptoms in a diary and/or by pushing specific buttons on the recorder.  The following day, the patient returns to their doctor to have the catheter removed.  Once the catheter is removed, the recorder is then attached to a computer so that that the data it has collected can be downloaded.  The data will then be analyzed and the results are usually displayed in a graphic form.  The entire pH monitoring test takes place over a 24 hour period.  

It is also important to note, that in addition to the catheter probe, a new device – a large capsule – has recently been developed for monitoring esophageal pH.  The capsule, which features an acid sensing probe, battery, and transmitter, is placed on a catheter and is inserted into the esophagus via the nose or mouth.  The capsule is attached with a clip to the lining of the esophagus.  When it is secured, the catheter is removed.  The capsule monitors acid in the esophagus, and transmits the information to a recorder that the patient wears on a belt.  The capsule continues to transmit for two days until the battery dies.  Five to seven days later, the capsule unclips from the esophagus, is digested, and passed in the stool.

The capsule is more comfortable for the patient due to the fact that it lacks the catheter.  However, the capsule has more limitations than the catheter method because it can only be used in the esophagus, and cannot be used in the pharynx or stomach for additional testing of symptoms that may be related to acid reflux.

Preparing for the pH monitoring test – Your doctor should tell you everything you need to know prior to the test.  However, unless otherwise directed by your doctor, you should expect to:
- Fast (no eating or drinking) 12 or more hours before the test
- Avoid smoking 12 or more hours before the test
- Avoid drinking alcohol 24 hours before the test
- You may be asked to refrain from taking certain medications 24 hours before the test.  Some of these medications may include:
* Adrenergic blockers
* Antacids
* Anticholinergics
* Cholinergics
* Corticosteroids
* H2 blockers
* Proton pump inhibitors

Note: don’t stop any medications unless directed by your doctor

You should also keep in mind that undergoing pH monitoring test may be uncomfortable, and some people find it embarrassing due to the catheter end that protrudes from the nose. If you believe this will be a problem for you, you may wish to consider taking the day off work.

What do the test results mean?  If results are normal, this would indicate that the patient does not suffer from excessive acid reflux that causes internal harm or damage.  However, if the test is being performed to determine how well acid reflux medication is working, normal results may indicate that the medication is doing its job.  Normal results vary from person to person, and also depend on the type of equipment and technique that is used.

Abnormal test results, on the other hand, indicate that the patient is experiencing an increase in frequency and/or duration of acid in the esophagus, which can be a sign of: heartburn, GERD, esophagitis (inflammation in the esophagus), esophageal scarring, dysphagia (difficulty swallowing) and Barrett’s esophagus .

Abnormal test results will vary from person to person, and based on the findings, patients may be urged to take other tests to determine the severity of their condition.  In addition, if the purpose of the test was to study the effectiveness of a person’s medication, abnormal test results may also be an indication that the medication being used to treat and/or prevent a person’s acid reflux is not working.

When is a pH monitoring test recommended? A pH monitoring test may be recommended by a doctor…
- If acid reflux symptoms continue with drug therapy
- If non-cardiac chest pain is experienced
- If unexplained ear/nose/throat symptoms (I.E. cough, sore throat, hoarseness) occur.
- Before or after anti-reflux surgery

Are there limitations to the test?  Yes.  Even though results may show that a patient has abnormal amounts of acid reflux, this does not mean that the symptoms he/she is experiencing are, in fact, caused by reflux.

Are there side effects?  Yes, but these are generally minimal.  Mild discomfort is typically felt in the back of the throat by patients when the catheter is in place, and when swallowing.  However, the majority of patients have no trouble eating, sleeping, or carrying out their daily activities.  If the capsule device is used, patients generally only feel discomfort in the chest when swallowing if passing food tugs on the capsule.  However, on occasion, some patients with the capsule report feeling discomfort when only saliva is swallowed.

Are there risks?  Although no significant risks have been reported, on very rare occasions, a few patients have experienced:
- Arrhythmias (abnormal heart rate) when the catheter is inserted
- Breathing in of gastric contents if vomiting is induced by the catheter

Is there an alternative to the pH monitoring test?  Currently there are no alternatives that allow doctors to obtain the information the pH monitoring test provides.

How much does a pH monitoring test cost?  The pH monitoring test typically costs anywhere from $200.00 - $400.00.  That being said, the price of the test varies depending on where the test is being done, and the equipment that is being used.  Cost may also depend on the individual’s specific needs or requirements before, during, or after the procedure.

Is the test covered by insurance?  Most major insurance companies, such as Medicare, should cover the test.  However, check with your specific insurance provider to find out if you will be covered, if there are any limits to the coverage, and also to attain authorization before you undergo the test.

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